Web and Shared Decision Making for Reserve/National Guard Women's PTSD Care

Women and OEF/OIF/OND Reserve/National Guard (RNG) war Veterans are among the fastest growing
groups of new VA users. Although PTSD is highly prevalent in this group of Veterans, most
choose not to seek care for a variety of reasons. Facilitating access to mental health (MH)
services for RNG OEF/OIF/OND female Veterans with post-traumatic stress disorder (PTSD) is
challenging and requires new approaches to outreach. Such approaches are urgently needed to
mediate the severity of post-deployment MH conditions, alleviate concerns over MH diagnoses,
and interrupt the cycle of chronicity found in many with PTSD. This gap between need for and
use of VA PTSD services suggests that further research is needed to understand specific
barriers to VA mental health (MH) care and VA PTSD evidence-based psychotherapy (EBP). A
web-based interface tailored to consumer needs has the potential to promote active engagement
by Veterans in their health care. Considering that OEF/OIF combat Veterans enrolled in VA
care report a preference to seek readjustment services or information over the internet, such
an approach may have important advantages for engaging this group. Furthermore, evidence
indicates that when patients are educated about their physical health conditions and
treatment alternatives, shared decision-making results in increased treatment participation,
better adherence to treatment recommendations, and better health outcomes. Although highly
promising, web-based and shared-decision making approaches to facilitating VA MH treatment
utilization are in need of further study.

In Phase 1 of the project, the investigators will use qualitative methods to assess VA
enrolled PTSD positive OEF/OIF/OND RNG female war Veterans' perceptions, preferences and
barriers and facilitators to accessing VA MH services and evidence based psychotherapy (EBP)
for PTSD. This information will be used to refine the investigators' existing web-based
interface to better address these issues. Satisfaction with the revised interface will then
be assessed. Phase 2 will focus on comparing the efficacy of two approaches to promoting VHA
initiation. Participants who screen positive for PTSD on the web interface will be randomly
assigned to: 1) Study concierge nurse case manager (NCM) facilitated shared decision making
to assist with VA MH evaluation and treatment; or 2) existing outreach (current standard of
care). Follow-up assessments will be conducted at 6 and 12 months to determine whether and
where participants sought MH care (from both VA and non-VA resources).

This study will provide valuable insights about this population's perceptions of VA MH
services and of PTSD EBP, as well as their evolving use of VA and other community resources
to address PTSD and other post-deployment MH needs. Furthermore, it will provide important
information regarding the efficacy of relatively inexpensive and resource-sparing
interventions that can be readily implemented within existing and emerging (e.g., Patient
Alight Care Teams [PACT]) models of VA care delivery. While the proposed web interface and
shared decision-making intervention are currently directed at RNG women Veterans
post-deployment, there are clear implications for expansion to other populations and
health/MH concerns, as well. Findings have important policy implications for several
operational partners heavily invested in the improved access and delivery of evidence-based
mental health care for Veterans with PTSD.

Inclusion Criteria:

- R/NG servicewomen who have returned from deployment in service of and/or to
Iraq/Afghanistan within the last 60 months.

Exclusion Criteria:

- Any disability that would impair individuals ability to provide consent and
participate in the interview.